Breaunnah Bloomer Jackson, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

W2866 Issued in TX

Practice address

3840 Hulen St
Fort Worth, TX 76107-7277

Phone

(817) 569-4300

NPI assigned

Jun 20, 2019

Last updated

Sep 28, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other names 1

• Breaunnah Elaine Bloomer Former name

Medicare fee-for-service enrollment

Enrolled in LA, MO, NY3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

PsychiatryAlso: Neuropsychiatry

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MCCD FL Psychiatry Services PAGroup PAC ID 4880064070, 751 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• MCCD FL Psychiatry Services PA

  dba Talkiatry

  • Psychiatry Physician
  • Jacksonville, FL
  • NPI 1659003457

  LA, MO

  Medicare reassignment Care Compare group NPD
• Louisiana State University School of Med in New Orleans Faculty Grou

  dba LSU Healthcare Network

  • Pediatrics Physician
  • New Orleans, LA
  • NPI 1932492626
  Medicare reassignment NPD
• Louisiana State University School of Medicine in New Orleans Faculty G

  dba LSU Healthcare Network

  • Multi-Specialty Clinic/Center
  • New Orleans, LA
  • NPI 1477582526
  Medicare reassignment NPD
• MCCD Psychiatry Services PLLC

  dba Talkiatry

  • Psychiatry Physician
  • New York, NY
  • NPI 1033750823
  Medicare reassignment
• Louisiana State University School of Medicine in New Orleans Faculty G

  dba Lsu Healthcare Network

  • Durable Medical Equipment & Medical Supplies
  • Kenner, LA
  • NPI 1316417629
  NPD
• Louisiana State University School of Medicine in New Orleans Faculty G

  dba LSU Healthcare Network Lab - Perdido

  • Clinical Medical Laboratory
  • New Orleans, LA
  • NPI 1508066283
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790553600000",
    "number": "1831759877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 E 104TH ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641314517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 HULEN ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761077277",
            "telephone_number": "817-569-4300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10918 Elm Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641342284",
            "country_code": "US",
            "telephone_number": "816-767-4346",
            "fax_number": "816-251-6367",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BREAUNNAH",
        "middle_name": "BLOOMER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-20",
        "last_updated": "2026-09-28",
        "certification_date": "2026-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "TX",
            "license": "W2866",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "LA",
            "license": "325879",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "313326",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "W2866",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BREAUNNAH",
            "last_name": "BLOOMER",
            "middle_name": "ELAINE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sarah Jacks, LPC
• Jacksboro Smiles by Wire, PLLC (All Smiles Dental & Orthodontics)
• Ahrielle Jackson
• Alysa Michele Jackson, MSW
• Ashli Brooke Jackson, RN
• Charles Jackson
• Chrystal Mae Jackson, COTA
• Clayton Ralph Jackson, MD
• D'Nika Jackson
• Illya Jackson

• Child & Adolescent Psychiatry Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Child & Adolescent Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.